CEG 8th December 2015 Hall

Present: Dr Arhin (Chair) Medical Centre

Dr Bansal Balfour Medical Centre

Dr Bhat Sai Medical Centre

Dr V Deveraja Sorrells Surgery

Dr Kallil The Surgery, Orsett

Dr N Raj Care Centre

Dr Raja The Surgery, Horndon on The Hill

Dr Ramachandran Appledore Surgery

Dr Sharma Neera Medical Centre

Dr Spraggins Hassengate Medical Centre

Dr Varghese Pear Tree Surgery

Dr Abeyewardene Dell Medical Centre

Dr Ahmed Hassengate Medical Centre

Dr Ajayi St Clements Health Centre

Dr Bellworthy Sancta Maria Medical Centre

Dr Bhat Sai Medical Centre

Dr Ukpaka Dilip Sabnis Medical Centre

Dr Cheung Ash Tree Surgery

Dr Gurjar Neera Medical Centre

Dr Hamilton Derry Court Medical Centre

Dr L Joseph The Grays Surgery

Dr Kadim Prime Care Medical Centre

Dr Lie Chadwell Medical Centre

Dr K Masson Milton Road Surgery

Dr M Roy Southend Road Surgery

Dr Sosanya St Clements Health Centre

Dr Yasin The Health Centre,

Vision Statement: The Health and care experience of the people of will be improved as a result of our working effectively together.

Davinder Masson Milton Road Surgery

Russell Vine Hassengate Medical Centre

Katie Webb Derry Court Medical Practice

June Mason The Health Centre, South Ockendon

Samita Patel Sai Medical Centre

Geemaa Diaat Sai Medical Centre

Tim Elwell-Sutton

Ceri Armstrong Thurrock Council

Mrs Ramachandran Appledore Surgery

Steve McKenna Neera Medical Centre

Lynn Heath Balfour Medical Centre

Sam Marlton The Grays Surgery

Sharron Carter Primecare Medical Centre

Dawn Mainhood Peartree Surgery

Les Sweetman NEL CSU

In Attendance: Rahul Chaudhari Thurrock CCG

Kelly Redston Thurrock CCG

Vicky Kankam Thurrock CCG

Gemma Curtis Thurrock CCG

Ade Olarinde Thurrock CCG

Joy Joses Thurrock CCG

Jeanette Hucey Thurrock CCG

Lesley Buckland Thurrock CCG

Christine Celentano Thurrock CCG

Alana Stokes Thurrock CCG

Ria Walsh Thurrock CCG

Urszula Pucilowska Thurrock CCG

1. Welcome & Apologies RA welcomed all to the meeting. There were no apologies to be noted.

RA asked if there were any declarations of interest that were not already on the register.

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.

2. Minutes of the meeting held on 10th November 2015 and Action Log Minutes of the previous meeting held on 13th October 2015 were reviewed and agreed as an accurate account.

A question was asked in the previous month’s meeting regarding the amount CCG pays for out of hours service, AO updated the group that this information will be shared as soon as it is available. A question was asked regarding the times of the safeguarding training, RA informed safeguarding times have already been booked for 2016. RA informed that there was nothing to update regarding Coach House.

3. Consultation and Engagement on HWB Strategy RA introduced Tim Ellwell-Sutton from Thurrock Council’s Public Health. TE-S informed the group that his team were working on the Health and Wellbeing strategy and the current consultation to revise this. TE-S asked the group if they were aware of the HWB strategy and noted some were. TE-S informed that the HWB strategy was a three year strategy setting high level goals for the HWB system and that his team were working on refreshing these goals. TE-S noted that Ian Wake gave a presentation to HWB Board and as a result the HWB Board had an overall feeling that the current strategy could be improved and that it was advised that the current strategy is good but not currently adding value.

TE-S advised that the HWB strategy is important as the population of Thurrock are living longer but not healthier lives, TE-S noted that most people aged 75+ have two or more long term conditions and that 70% of health and social care spend is spent on LTCs with 22% of Thurrock’s children and 32% of adults are obese. TE-S advised over 7,000 patients with diabetes are costing the NHS circa £20,000,000 and over 18,000 patients are pre-diabetic. It was also noted that a boy living in today will die almost a decade earlier than a boy living in Orsett. TE-S advised that 9200 people in Thurrock do not know they have high blood pressure putting them at significantly increased risk of stroke and heart disease, it was noted that employment, housing, education and the environment have a significantly bigger impact on health than health or social care services

TE-S informed the group that the new strategy will improve communication between professionals with ideas being fed into the HWB strategy rather that HWB driving their ideas down. TE-S noted that the HWB strategy needs to be driven by what is needed and what works for the population of Thurrock, coordinating and adding value to what is already in place. TE-S advised that there are 4 areas of priority and informed the group that these are, prevention and early intervention, building strong and sustainable communities, strengthening the mental and emotional and finally health and social care transformation. TE-S noted that communities have and important part to play within the new HWB strategy.

TE-S noted that the progression from his team so far was the development of a formal consultation process that has been distributed to hear views on the new strategy, and that highlighted goals are being viewed to be set so that his team can work backwards from there to achieve this. TE-S advised that accountably is crucial for the new strategy to be successful and professionals should be able to come to HWB board to address these issues where an important strategy will be put into practice to drive the agenda. TE-S informed the group that they had agreed on priority areas of Thurrock and started to develop an outcome framework.

TE-S brought attention to the Millennium Development Goals and noted that in the year 2000 there was an international agreement to work on set goals with their strategy driving the agenda having professionals know how their work was contributing to these goals. TE-S informed that the MDG’s were a success and suggested something similar is done for HWB strategy and gave examples of set targets and the indicators which justified those targets. TE-S noted that these are pulmonary ideas and this is what the consultation period is trying to address.

RV asked a question regarding the issue of patients not attending appointments they have

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.

booked. TE-S advised this could be issues universally not just for GP appointments. A question was asked regarding what the budget is for the new strategy. TE-S informed the group that there is no pool budget.

RA asked how TE-S envisioned the new strategy to be enforced. TE-S advised that the HWB strategy cannot enforce what it does, but would like professionals to make a public commitment to help with having clear goals and holding people accountable.

4. Primary Care Update RC introduced himself to the group as the Head of Primary Care. RC informed members that Thurrock CCG had but in a bid in August to help support practices update their policies and pathways. RC advised that in October the CCG had successfully been awarded £100,000 from the Primary Care Development Fund and that part of the funding has been used to create a new Primary Care Team. The team will be the link between the CCG and practices, RC advised that he and his team are working with NHSE towards Primary Care issues. RC introduced GC (Tilbury), VK (South Ockendon and Grays), and KR (Stanford-le-Hope) as Primary Care Managers for the different localities in Thurrock, with one post still vacant. RC informed members that the Primary Care team will be carrying out practice visits. RC asked the group to ensure they take their practice pack in orange folders handed out to them at registration.

A question was asked regarding the CCG working towards undertaking Thursday afternoons. RC informed that this is a national directive. AO noted that he understands frustration regarding the matter relating to the primary care contract but noted that this does sit with NHSE and the service is transferred from SEEDS. RV agreed that the CCG cannot prepare anything relating to Thursday afternoons, RV added he was working on trying to resolve this matter but not enough members signed up. AO noted that IC24 is the current out of hour’s provider.

VK advised members that the team is aiming to be the Primary Care link between Thurrock CCG and Practices, to help with support and provide practices with the tools to apply for future AQP bids and to work with practices to meet individual CCG QIPP targets QP+ Incentives. VK also noted that the team will be helping to promote the use of e-referral, community pathway and monitoring systems, to work with Practices to resolve issues and if necessary liaise with service providers on their behalf. VK addressed that some areas will require the help of the team for example NELIE, CCG website sign up, PPG’s and the friends and family test, dementia registers and promoting the weekend health hubs.

KR spoke about practice responsibilities and the expectations the team had for practices, KR noted that some of these responsibilities include, full commitment from each practice with a named practice lead that can agree and see through actions, practices to be open to information, CCGs feedback and examples of shared best practice across Thurrock, pro-active practice management of tasks and action and for practices clear and concise when providing information to the Practice concerns inbox.

GC informed members that the team had made contact with all Thurrock practices and visited 23 out of 32 practices. GC noted that the team had developed and emailed AQP action plans to visited practices while offering on-going support as practices work through their action plan and had scheduled follow up second visits as requested. GC advised members that the team had begun following up and resolving current practice concerns. GC informed that the team had organised with NELCSU to provide practices with NELIE training and on-going support for systems. GC brought attention to the practice folder’s and noted that all the information in the folders was currently on the CCG website, GC encouraged members to sign up. GC advised the group that the team had facilitated and was encouraging the sharing of good practice and encouraged peer to peer support amongst practice manager’s colleagues helping promote the use of Community pathways. GC noted that the team had identified support from Practice Manager’s to help with Dementia Registers and worked closely with Operational Manager for weekend Health Hub to resolve practice concerns and issues.

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.

5. Primary Care Hub Update MS gave an update on the current development of the locality hubs and noted that all four localities were well established however more use of the hubs could be beneficial by increasing the number of practices using the hubs and encouraging more doctors and nurses to work in the hubs. MS noted that patients benefit seeing experienced professionals working at the hubs. MS advised the hubs are seeing a wide array of patients just like routine general practice and as word spreads the hubs are seeing more of the ‘commuter population’. MS also informed the members that the hubs are picking up new cancer diagnoses with detailed audits to follow.

MS updated the group regarding current usage of the weekend hubs with Tilbury and Ockendon being the busier hubs but noted that they have higher DNA rates and noted an appointment card system has been introduced to tackle this. MS advised that Sundays are generally quieter and Grays having low utilisation overall. MS noted that the friends and family test was carried out at the hubs with most patients selecting ‘extremely likely’ to recommend the hubs showing patients are generally happy with the service. MS also advised that the smear service is increasing in the hubs for women who work and cannot get appointments.

MS informed the members that there were still some challenges persuading practices to host the hubs and agreeing to patient record sharing nonetheless IT was the biggest issue. MS advised that recurrent extra funds in Thurrock represents a real opportunity for practices to work together and be responsive to practice needs and noted that this also would enable the support for practices with evening sessions.

MS updated the members on proposed opening times for the hubs over the Christmas and New Year period.

6. Practice Concerns RA suggested the group use the correct email address for any practice concerns.

AO updated on GP IT system, and noted all practices should have received the GP IT service provision. AO informed the group that this was a national exercise that requires every practice to sign up to this with the CCG and all provisions need signing by a partner. AO informed that a new survey was distributed and the survey needs to be completed for the GP IT provision, this would help improve the GP IT service. AO noted that the deadline to sign up for this is end of January 2016. AO informed that any questions regarding the document contact Les Sweetman at the CSU. LS noted that all practices must sign this document and return it by the deadline as otherwise practices that do not sign up will be taking on responsibility for their own IT funding, repair, services and equipment. AO noted that this is the perfect opportunity to sign up as currently NELCSU are undertaking an equipment refresh for practices. LS asked the group if any practices have not received their provisions to let him know and a copy will be re-sent.

11. AOB LB gave update from the CRG meeting held on 26th November 2015 regarding the presentation Francoise Price gave on medicines management wastage. LB noted that if anyone would like a copy of this presentation it can be sent out. LB informed the group that the most expensive medicine is the one that the patient never takes and informed the group that drug wastage is approximately £2,000,000 per annum in Thurrock. LB explained that FP gave figures on patients who take their prescribed medication explaining that only 16% of patients who are prescribed a new medicine and take it as recommended, experience no problems and ten days after starting a medicine, almost a third of patients are already non-adherent, of these patients 55% do not realise they are not taking their medicines correctly, whilst 45% are intentionally non-adherent. Pic on presentation. LB noted that FP had given some solutions to tackle the wastage of medicines these were, more public engagement and education on the use of medicines a patient is taking, more publicity regarding the costs of wastage, medicines use reviews and repeat dispensing and that this could be done by improving communication between health professionals. LB also noted that Alan Hudson the chair of this month’s CRG meeting is

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.

arranging with other PPG members for a PPG virtual group to be started up in Thurrock to share issues around the Thurrock locality.

RA informed the group that Tuesday cover would be covered by IC24 and also noted that the CCG are in the process of revising 2016/2017 QIPP plans.

Date of Next Meeting 12th January 2015 at

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.